Bones and Crohn's: estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density.
BACKGROUND
Reduced bone mineral density (BMD) and osteoporosis are frequent in Crohn's disease (CD), but the underlying mechanisms are still not fully understood. Deficiency of sex steroids, especially estradiol (E2), is an established risk factor in postmenopausal osteoporosis.


OBJECTIVE
To assess if hormonal deficiencies in male CD patients are frequent we investigated both, sex steroids, bone density and bone metabolism markers.


METHODS
111 male CD patients underwent osteodensitometry (DXA) of the spine (L1-L4). Disease related data were recorded. Disease activity was estimated using Crohn's disease activity index (CDAI). Testosterone (T), dihydrotestosterone (DHT), estradiol (E2), sex hormone binding globulin (SHBG), Osteocalcin and carboxyterminal cross-linked telopeptids (ICTP) were measured in 111 patients and 99 age-matched controls.


RESULTS
Patients had lower T, E2 and SHBG serum levels (p < 0.001) compared to age-matched controls. E2 deficiency was seen in 30 (27.0%) and T deficiency in 3 (2.7%) patients but only in 5 (5.1%) and 1 (1%) controls. Patients with E2 deficiency had significantly decreased T and DHT serum levels. Use of corticosteroids for 3 of 12 months was associated with lower E2 levels (p < 0.05). Patients with life-time steroids >10 g had lower BMD. 32 (28.8%) patients showed osteoporosis, 55 (49.5%) osteopenia and 24 (21.6%) had normal BMD. Patients with normal or decreased BMD showed no significant difference in their hormonal status. No correlation between markers of bone turnover and sex steroids could be found. ICTP was increased in CD patients (p < 0.001), and patients with osteoporosis had higher ICTP levels than those with normal BMD.


CONCLUSIONS
We found an altered hormonal status--i.e. E2 and, to a lesser extent T deficiency--in male CD patients but failed to show an association to bone density or markers of bone turnover. The role of E2 in the negative skeletal balance in males with CD, analogous to E2 deficiency in postmenopausal females, deserves further attention.
Klaus
J
J
University of Ulm, Department of Internal Medicine I, Robert Koch Str, 8, 89081 Ulm, Germany. jochen.klaus@uniklinik-ulm.de
Reinshagen
M
M
Adler
G
G
Boehm
Bo
B
von Tirpitz
C
C
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000503:physiopathology*; D016022:Case-Control Studies; D024042:Collagen Type I; D003424:Crohn Disease / Q000097:blood / Q000503:physiopathology*; D013196:Dihydrotestosterone / Q000097:blood; D004958:Estradiol / Q000097:blood / Q000172:deficiency* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010024:Osteoporosis / Q000209:etiology* / Q000503:physiopathology*; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides; D011347:Procollagen / Q000097:blood; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; D012738:Sex Hormone-Binding Globulin; C052929:collagen type I trimeric cross-linked peptide; D013196:Dihydrotestosterone; D015675:Osteocalcin; D013739:Testosterone; D004958:Estradiol